Assessing Surgical Extent in Endoscopic Sinus Surgery: A Scoping Review of Scoring Systems

Area of Science:

• Otolaryngology
• Surgical Outcomes Research
• Medical Device Evaluation

Background:

• Endoscopic sinus surgery (ESS) exhibits significant variability in dissection extent, impacting chronic rhinosinusitis patient outcomes.
• This heterogeneity may affect revision rates and response to biologic therapies, necessitating standardized assessment tools.

Purpose of the Study:

• To identify and characterize existing instruments for evaluating surgical extent following ESS.
• To differentiate between surgical extent and anatomical completeness achieved post-ESS.

Main Methods:

• A scoping review adhering to PRISMA-ScR guidelines.
• Systematic literature searches were conducted across PubMed/MEDLINE, Scopus, and Web of Science.

Main Results:

• Eleven instruments were identified across 21 studies, including CT-based scores (e.g., ACCESS, CoSI) and intraoperative classifications (e.g., LOEM).
• A distinction was made between surgical extent (procedure) and completeness (anatomical result); CT-based tools assess completeness, while intraoperative tools assess extent.
• The Completion of Surgery Index (CoSI) showed consistent outcome associations, predicting benefit from revision ESS. Amsterdam Classification of Completeness of Endoscopic Sinus Surgery (ACCESS) showed potential in predicting biologic response.

Conclusions:

• CT-based and intraoperative instruments measure distinct aspects of prior ESS and should be chosen based on the clinical question.
• Standardized assessment of surgical extent is crucial for clinical decision-making, given its link to outcomes and biologic therapy response.
• Prospective validation of these instruments is essential.